Positive Patient Outcomes Are Still Hampered by Patient Identification Issues

December 17, 2020/10060 views / 0 Comments/in BLOG, healthcare, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

At this point in time, virtually everyone knows about the coronavirus pandemic, unless they have been living under a rock. Unfortunately, COVID-19’s effects on the US have been disastrous, especially on its healthcare system. The numbers for the US are mindboggling – over 13 million people have contracted COVID-19, whereas over 268,000 people have lost their lives. Moreover, cases are increasing rapidly as was predicted by experts. Things are more serious than ever – restrictions are being placed in many states, encouraging social distancing and fewer social gatherings. Suffice to say, the novel coronavirus has been pushing healthcare to its limits. While doing so, it has also highlighted the existing issues that have been hampering positive patient outcomes for years and need to be addressed quickly.

Let’s take a closer look at one of the overlooked but more prominent issues – patient misidentification, why it’s such a mess, what caregivers are doing to address it, and how RightPatient ensures positive patient identification for responsible caregivers.

Patient misidentification and how it hampers positive patient outcomes

It is quite straightforward – patient misidentification refers to patients being associated with the wrong, incomplete, inconsistent, or fragmented EHR (electronic health record). This usually happens at registration desks as well as EDs (emergency departments). But it sounds so simple, right? Actually, patient identification errors are much more complicated than that.

Both registration desks and EDs are high-pressure environments where patients’ EHRs need to be identified quickly and accurately. Unfortunately, issues such as duplicate medical records, common patient names or demographics, and basic search functionalities lead to confusion, after which patient record mix-ups occur. While this was a simplified example, this is how most misidentification cases occur, leading to lower positive patient outcomes down the line.

Thousands of patients are affected every year – facing delayed care, repeated lab tests, shocking bills, detrimental healthcare outcomes, medical errors, and even deaths. Using an effective, standardized patient identifier across the hospitals would be enough to eliminate such issues, but there’s a snag.

Why is patient identification such a mess?

Well, a state-funded UPI (unique patient identifier) was supposed to be created to ensure accurate patient identification, eliminating all the issues associated with mix-ups, and ensuring positive patient outcomes. Fast forward around two decades, and there’s still not a national patient identifier on the horizon.

A ban has been in effect since the beginning – Section 510 of the Labor-HHS Appropriations bill restricts the use of federal funding to allow HHS (the US Department of Health and Human Services) from creating or adopting a unique patient identifier.

For the past twenty years or so, healthcare providers have been struggling with patient identification errors and as a result, are experiencing duplicate medical records, overlays, detrimental healthcare outcomes, lower scores, denied claims, and more. Moreover, medical identity theft can be prevented in real-time if patients can be properly identified during registration.

While it has been an overlooked issue, patient misidentification has been causing adverse outcomes during the pandemic – repeated testing, medical errors, lost results, and so on. Imagine if a COVID-19 test result was sent to the wrong person and they were admitted into the isolation wing!

What healthcare providers are doing

Every year, healthcare providers and experts come together to urge Congress and the Senate to abolish the ban so that a unique patient identifier can be made. Unfortunately, they’ve been turned down every year, leading to another year of struggle.

However, responsible healthcare providers are not waiting around for a unique patient identifier – they are implementing effective solutions to prevent mix-ups, the most feasible one being RightPatient.

RightPatient ensures positive patient outcomes

RightPatient is a touchless biometric patient identification solution that has been helping responsible healthcare providers for years. It uses the patients’ faces to verify their identities and provide accurate medical records within seconds.

After appointment scheduling, patients need to provide a selfie and a photo of their driver’s license. RightPatient automatically compares the photos for a match, verifying patient identification remotely. New patients are provided with biometric credentials for future use. It locks the medical records with patients’ photos to prevent mix-ups. Moreover, the platform is flexible enough to be used at any touchpoint, making it ideal for telehealth sessions too.

Within hospitals, the patients only need to look at the camera – the platform compares the live picture with the one saved with the EHR. The accurate medical records are provided within seconds, ensuring positive patient identification, enhancing healthcare outcomes, and preventing medical errors and all other issues associated with misidentification. Moreover, it can red-flag fraudsters who try to assume patients’ identities, preventing medical identity theft in real-time.

RightPatient is the most feasible patient identification solution currently because it is contactless – leading to a more hygienic environment and reducing infection control issues, something which is crucial for COVID-19.

Even if the UPI gets approval in the future, it will take years for it to be created, implemented, and be effective. Forward-thinking caregivers will thus be coupling it with an experienced patient identifier like RightPatient to ensure immaculate identification across the care continuum.

Healthcare providers such as Baptist Health South Florida, MediSys Health, Grady Health, and Catholic Health Services of Long Island have been using RightPatient to ensure positive patient outcomes, eliminate misidentification, and ensure patient safety across their facilities.

2021’s Patient Safety Goals Show that Patient Identification Is the Topmost Concern

December 15, 2020/12948 views / 0 Comments/in BLOG, EHR, healthcare, Infection Control, Patient Errors, Patient Experience, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

This has been a devastating year all around for the entire world due to the COVID-19 pandemic and its effects. Even though there have been a lot of issues within the US healthcare system that surfaced during the pandemic, one of the more prominent problems healthcare providers faced (and are still facing) is patient identification errors. Experts have talked about and how patient misidentification is detrimental to both patient safety and quality healthcare. Thus, it isn’t surprising that improving the accuracy of patient identification takes the top spot of 2021’s patient safety goals as per the Joint Commission.

Let’s take a look at the new goals set by the Joint Commission, why improving patient identification can help achieve the other goals, and how RightPatient can help healthcare providers.

Patient safety goals for next year

The Joint Commission outlines the top patient safety concerns that healthcare providers must address each year based on available information. Patient identification has been on the list almost constantly because errors can cause a lot of adverse effects for patient safety, healthcare outcomes, hospitals’ finances, etc. – more on that later.

Let’s take a look at the national patient safety goals for the upcoming year 2021:

Identify patients accurately.
Improve staff communication.
Safely use medicines.
Reduce patient harm by improving clinical alarm systems.
Reduce hospital-acquired infections.
Identify patient safety risks within the healthcare facility.
Prevent surgical mistakes.

While these are different issues, some of these patient safety goals can be met, or at least the unwanted incidents can be reduced, by ensuring accurate patient identification with RightPatient.

How patient identification ties in with other patient safety goals

While patient identification errors might seem trivial to some, there have been many complaints about the different problems which were consequences of misidentification – not finding the accurate medical record, delays in care, repeated tests, etc. As a result, many healthcare experts are clamoring for the mythical national patient identifier once again this year. However, national patient identifier or not, patient identification must be accurate to mitigate patient safety issues. Moreover, by ensuring accurate patient identification, other patient safety goals can be met – let’s explore how.

Improving staff communication

Communication is crucial for ensuring improved healthcare outcomes and reducing patient safety incidents across the care continuum. By ensuring that patient data is accurate and consistent, it will enhance outcomes, as most patient safety incidents occur when patient data is corrupted, fragmented, obsolete, or inconsistent.

When patients are accurately identified every time at any touchpoint across the hospital, it helps maintain patient data integrity, ensures that the correct information regarding the patient is used, leading to accurate test results being passed to the appropriate personnel at the right time.

Safely use medicines

Many patient safety incidents occur because of simply giving the wrong patients the wrong medicine, incorrect doses, and/or at the wrong time, leading to preventable medical errors. While clearly labeling and rechecking do help, many medical errors occur because of patient misidentification. For instance, if the patient is misidentified right from registration, rechecking the name or information won’t help, as it belongs to someone else entirely.

If patients are accurately identified from the start, not only will patient misidentification be eliminated, but medical errors will be prevented too, enhancing patient safety and improving healthcare outcomes in the process.

Prevent surgical mistakes

This is somewhat related to the previous point, but medical record mix-ups do lead to the wrong surgeries being performed as well. If the patient is misidentified during registration, rechecking won’t help, as it will lead to the wrong surgery being performed on the wrong patient.

Only by identifying patients accurately at the front-end can mistakes such as patient record mix-ups be prevented effectively.

Reduce hospital-acquired infections

Now, how can patient identification reduce hospital-acquired infections (HAIs)?

Well, as there is no standardized patient identifier present in the US healthcare system, many caregivers are using different solutions to fit their needs. However, many of these solutions can be ineffective and are touch-based, which is a major challenge, given the pandemic. These touch-based solutions can lead to infection control issues, as they require contact by multiple individuals. If an infected person uses it, the subsequent patients will be infected as well, leading to a disastrous situation.

However, many caregivers are using innovative solutions such as RightPatient – a touchless biometric patient identification platform. It uses the patients’ photos to ensure that the patients are who they claim to be, preventing patient identification errors, mix-ups, duplicate medical records, and more. It can also be used across any touchpoint, starting from appointment scheduling.

How RightPatient works – improving patient safety

Patients need to provide a selfie and a photo of their driver’s license – the platform automatically compares them for a match, remotely verifying their identities. During inpatient visits, the patients only need to look at the camera – the platform provides accurate medical records within seconds after comparing the live picture with the saved one.

RightPatient thus prevents HAIs as it is a contactless solution, enhancing patient safety, improving patient outcomes, and reducing preventable medical errors across the care continuum.

Protect Patient Information During Telehealth Visits by Addressing 7 Issues

December 14, 2020/11828 views / 0 Comments/in BLOG, Data Integrity, healthcare, Medical Identity Theft, Patient Data, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety, Telehealth /by Matt Gibson

The pandemic has been spreading like wildfire, and its effects on the US have been devastating – over 12 million people have been affected by it. Hospitals barely kept up with the pandemic’s effects when it first hit the country. Now that the winter has arrived, COVID-19 cases are increasing rapidly. One of the previously overlooked aspects of healthcare, known as telehealth, has gained much attention during this period. As it ensures that non-critical patients could receive healthcare services without the risk of contracting the virus, officials were quick to redirect such patients to telehealth. As a result, telehealth usage surged and it finally got the attention it deserved. However, like everything else, it also has pros and cons, and healthcare providers must address the risks associated with telehealth to protect patient information, improve healthcare outcomes, and enhance patient safety – let’s explore.

7 issues healthcare providers must consider regarding telehealth

Cybersecurity risks

Since telehealth requires the internet, hackers are always working on new and innovative ways to steal patient data and sell it to unethical individuals, who will later assume the identities of the victims to use the healthcare services fraudulently.

Phishing attacks

One of the most common tools used by hackers is phishing, and while simple, it is quite effective. Hackers pose as officials and lead the unassuming healthcare employees to click on the links they provide. As a result, hackers gain access to the targets’ accounts and can access or steal information.

While these attacks happened prior to the pandemic, telehealth is at huge risk as well now. Phishing tactics that are currently used rely on social networking, and it might lead to users being victims down the line. Moreover, there are many instances where hackers posed as credible organizations like Microsoft.

Hackers

Hackers have been constantly trying to access patient information to steal or use it for themselves, and the sudden growth of telehealth makes it much easier for them. If telehealth sessions are done using unsecured networks, hackers can just add themselves to the session and steal patient information. They are now targeting providers using obsolete systems that have security issues and vulnerabilities, as that will be much easier to gain access to.

Uncertainty regarding rapidly changing rules

As the situation surrounding COVID-19 is evolving, the rules are being constantly updated. Thus, it is quite crucial to ensure that providers are up to date regarding the changes surrounding telehealth usage in order to ensure telehealth services are delivered in a manner that can protect patient information.

Fraudulent activities

There’s a much broader scope for fraud in telehealth than inpatient visits – such as kickbacks, charging for services that weren’t actually provided, misrepresentation, and so on. Even CMS is closely monitoring in order to reduce such risks. Providers must ensure that they are not being charged falsely by having all the required documentation on hand at all times.

Patient misidentification

An issue that can be commonly seen during inpatient visits, patient identification errors may very well bleed over to virtual sessions as well. The premise is just the same – misidentification at the front-end due to issues such as duplicate medical records, overlays, or human errors leading to medical record mix-ups. All of this ultimately leads to delayed care, detrimental outcomes, and compromised patient safety. Thus, accurate and secure patient identification is crucial.

Medical identity theft

One can safely assume that medical identity theft is the end result of most of the concerns listed above. Let’s explore why it is so prevalent and how it takes place.

Well, the hackers aim to steal patient information from healthcare providers, and the ones who are high-risk are the ones that have vulnerabilities such as keeping patient data unencrypted or using unsecured means to transmit or receive it. After stealing the information, they sell it to hackers for steep prices – up to $1000!

This information is available on the black market, and fraudsters buy it to pose as the victims. Armed with the credentials of the victims, they can easily pass themselves off as the patients and have access to healthcare services, expensive medical equipment, prescription drugs, and more. That’s not all – the victims will be fraudulently billed for the services used by the impostors.

Experts are predicting that such cases will transpire with telehealth visits too, and with the issues listed above, it won’t be that hard. Fortunately, RightPatient can prevent medical identity theft and protect patient information.

RightPatient can protect patients during telehealth visits

RightPatient is a touchless biometric patient identification platform that uses patients’ faces to verify their identities. While data breaches might seem inevitable, RightPatient can mitigate its losses by preventing medical identity theft in real-time.

Patients are required to take a selfie and submit a photo of their driver’s license after registration. The platform automatically compares the photos for a match and verifies patients’ identities remotely, making it ideal for telehealth sessions as well. Fraudsters are red-flagged whenever they try to use the platform and pass themselves off as the patient. RightPatient helps protect patient information, enhance patient safety, and accurately identify patients across the care continuum.

Infection Control in Hospitals is Imperative as COVID-19 Cases Increase

November 27, 2020/12859 views / 0 Comments/in BLOG, COVID-19, healthcare, Infection Control, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

COVID-19 is a phenomenon that has crippled almost the entire world. Even in those very rare countries where it didn’t infect many people, it did hurt their economies. The majority of developing countries are severely affected by the novel virus, leading to disruption in international businesses and global transactions. However, one can safely say that COVID-19 has affected America the worst – it is currently seeing huge spikes across the states, where officials are introducing new safety measures. Let’s take a look at the most recent record-breaking statistics of US COVID cases, some measures officials are implementing to mitigate its spread, and practices that will help ensure infection control in hospitals – improving patient safety and quality of care.

US COVID-19 cases keep breaking records

Unfortunately, the US has the highest number of COVID-19 cases in the world – over 11.3 million! Moreover, it keeps on making new records: November 13 saw 184,514 new cases, according to John Hopkins University. This is in line with experts’ predictions – many stated that things will get worse during the fall. Ultimately, all of this will add to the huge amount of pressure healthcare providers are already facing – the COVID Tracking Project saw over 68,000 hospitalizations on November 13 where 6% of the patients were on ventilators and 19% in ICUs.

Needless to say, these numbers are frightening, with officials introducing measures to mitigate further spread. Let’s review some of the emergency measures introduced within some states.

Some recent measures to mitigate COVID-19’s spread

Oregon will see restrictions on gyms, restaurants, and retail stores. Virginia issued a mask mandate for anyone older than five starting on the 15th of November. New Mexico will be facing a two-week shutdown that consists of nonessential activities starting from 16th November. Many other locations are seeing similar restrictions to ensure social distancing practices as a result of ever-increasing cases.

While these measures are in place to lower potential COVID-19 cases, infection control in hospitals must be ensured so that cases don’t spread within healthcare facilities. Let’s explore why this is important.

Why is infection control in hospitals important?

Of healthcare providers’ many responsibilities, preventing hospital-acquired infections (HAIs) has been a topmost priority for many of them. Hospitals are constantly looking to improve practices that enhance infection control and prevent HAIs. It is a crucial role of any hospital because, if not ensured, it will lead to compromised patient safety, undesirable healthcare outcomes, and create a chain of events that will jeopardize the entire healthcare facility. However, prior to the pandemic, HAIs used to be a headache of healthcare providers only; but now, contracting diseases is the concern of virtually everyone, especially those in hospitals.

COVID-19 has shown how effective communication can be in this day and age – any new update regarding the novel virus can be shared and seen by anyone, thanks to the internet. Almost everyone has extensive knowledge about the do’s and don’ts, and they are quite reluctant to visit hospitals since they know that’s where the COVID-19 patients are going. Thus, healthcare providers need to ensure infection control in hospitals and enhance patient safety as well as the safety of the frontline staff members. Let’s take a look at how hospitals can reduce HAIs, some of which are according to WHO, and improve healthcare outcomes as a result.

Practices to ensure infection control in hospitals

Create an effective infection control policy

The foundation of having zero to minimal HAIs is to have an effective infection control policy at hand. Healthcare providers wanting strict infection control must plan for it in advance, and this plan should contain guidelines for dealing with HAIs, identifying affected patients, locations to place the patients in isolation, and the duration of such events.

Washing hands thoroughly and regularly

While this might seem obvious at this point, it is still one of the most important practices to ensure infection control in hospitals and save lives in the process. Washing hands regularly with liquids containing antimicrobial agents for twenty seconds is a must, especially after interacting with extractions, contaminated items, blood, secretions, etc. Keep sanitizers within a short distance of each other so that patients and caregivers both have access to them. If possible, use automatic dispensers to make it a touchless and safer experience for everyone involved.

Enforce PPE usage

PPE is a term that has been tossed around since the beginning of the pandemic, and for good reason. While healthcare professionals have been using it for decades to prevent HAIs, virtually everyone uses some form of PPE nowadays to protect themselves. Unfortunately, not everyone follows best practices, which will ultimately put others at risk.

Enforcing PPE usage for everyone within a healthcare facility is a good practice, regardless of their designation. Simply putting up signs saying “No PPE, No Service” will be quite effective for patients. For the healthcare staff members, surgical masks, face shields, gloves, gowns, etc., must always be present whenever they are within the facilities.

Keeping surfaces clean

Viruses linger on surfaces for days, and keeping them clean is the best solution to prevent HAIs. We can significantly reduce HAIs by monitoring the materials and environmental surfaces that are touched frequently and disinfecting them regularly and thoroughly, such as beds, handles, etc.

Using touchless solutions that ensure infection control

While many touchless solutions will be popping up within the next few years, there is one that is already being used by many healthcare providers to prevent infection control issues – RightPatient. It is a touchless patient identification platform that uses patients’ photos to lock medical records and verify their identities. Enrolled patients only need to look at the camera – the platform matches the live photo with the saved one, providing the appropriate medical record within seconds without requiring any physical contact, and ensuring patient safety and hygiene.

Hospitals Can Reduce Denied Claims By Preventing 6 Issues

November 26, 2020/12566 views / 0 Comments/in BLOG, Denied Claims, healthcare, Medical Record Mix-ups, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety, Revenue Cycle Management /by Matt Gibson

The COVID-19 pandemic has caused arguably the worst financial strain the US healthcare system has ever experienced. While all healthcare systems around the world are facing similar challenges, the US is currently witnessing the highest number of cases in the world – over 10 million people! As the numbers continue to increase, so do the losses, and healthcare providers must reduce their costs to cope with these unprecedented numbers. That being said, reducing denied claims is more crucial than ever, as they cause caregivers to lose a significant portion of their revenue. Let’s take a look at denied claims, how they affect caregivers, and six errors caregivers must avoid to improve revenue cycle within their facilities, leading to improved bottom lines.

What are denied claims?

While this is a common term heard within healthcare facilities, many still don’t understand how much loss can be incurred for any given healthcare provider. To put it into perspective, Change Healthcare stated that denied claims can cost around $4.9 million on average for any hospital. But what are claim denials?

Simply put, denied claims are those that are classified as unpayable by the payers (insurance companies) after they receive the process them. Claim denials often occur because there’s some form of error present within the claim that becomes apparent after processing. Issues such as missing information, sending the wrong information, and non-covered services are the common reasons why claims are denied. However, there’s another form known as a rejected claim.

When one or more issues are detected within a claim even before it was accepted or processed by the insurance company, it is classified as a rejected claim. Coding errors and mismatched procedures are the most likely causes that lead to such claims.

How do denied claims affect healthcare providers?

Claim denials are a massive pain point for healthcare providers as they decrease already razor-thin margins, significantly increase collection times and reimbursement, and consume valuable resources such as FTEs (full-time equivalent).

As we can see, claim denials significantly affect a hospital’s bottom line. Moreover, while 63% of claim denials can be recovered down the line, the administrative costs are a nightmare – $118 per claim. Thus, it’s better to avoid denied claims right from the beginning.

That being said, let’s take a look at the top six issues that lead to claims being denied.

6 issues to avoid that can help reduce denied claims

Absence of information

One of the most common mistakes that lead to claim denials is sending inadequate information to the insurance company. Even the smallest details such as date of surgery, date of onset, demographic information, etc., are liable to classify claims as unpayable.

Issues with coding

Using an obsolete codebook or incorrect codes is a common mistake that leads to claim denials, as they cause revenue leakage.

Insufficient documentation occurs when there are missing elements required for the services billed, and it is extremely crucial to prevent them. Thus, immaculate documentation is critical to prevent legit claims from being converted to denied ones. If proper documentation is not present when coding and submitting claims, then insurance companies classify them as denied because they consider that the services were not performed.

Duplicate bills

Duplicate claims are quite common and are usually attributed to human errors. These occur when the revenue cycle staff forgets to remove a claim from the patient’s account after resubmitting the claim. However, as claims processing systems consist of tools that help detect duplicate ones, the systems flag and classify the anomalies as either suspect duplicates or exact duplicates. As the entire healthcare process is quite complex in nature, it might lead to original claims appearing as duplicate ones – resulting in a claim denial.

Simply preventing duplicate claims is not enough. Properly coding the billed service with required modifiers and documentation is crucial to help identify the bill as original and not as a duplicate.

Not filing claims at the right time

Various rules and regulations must be followed regarding claims and failing to do so will result in even legitimate claims being denied. For instance, the Affordable Care Act reduced the deadline window for submitting Medicare claims to 12 months from 15-27 months after the date of service.

Not verifying coverage eligibility for the services provided

Healthcare insurance is quite volatile, leading to constant changes. As a result, it is crucial to check eligibility every time services are provided to the patients. While this might seem like a tedious task, it will help save a significant amount of money down the line.

Whenever a patient comes in for healthcare services, it is essential to check whether the coverage is still in place (read: not terminated), the service provided is covered by the plan, and the cap has not yet been reached. However, a healthcare provider can cover its services using plans with a cap as long as it follows provided guidelines meticulously and provides the required documentation.

Patient identification errors

One of the biggest problems that leads to claim denials is patient identification errors. Imagine this: if a patient is not accurately identified right from the start, the claim will be filed against the wrong medical record and the insurance company may ultimately classify it as denied. To ensure that claims are not denied and are processed smoothly, patient identification is a must. That’s where RightPatient can help.

RightPatient is a touchless biometric patient identification platform that locks patients’ records with their photos – protecting patent data. It can even remotely identify patients, making it ideal to be used across the care continuum and any touchpoint.

After scheduling an appointment, patients need to provide a personal photo and a photo of their driver’s license. RightPatient matches the photos to verify their identities, and when patients arrive at the hospital, all they need to do is look at the camera. The platform matches the saved photo with the live one, instantly eliminating any chances of the claims being denied.

Healthcare providers can reduce denied claims, optimize the revenue cycle, avoid duplicate medical records, improve healthcare outcomes, and even prevent medical identity theft with RightPatient – enhancing patient safety in the process.

Improving Patient Safety Depends on Error-Free ADT E-Notifications

November 25, 2020/11461 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, healthcare, Medical Record Mix-ups, Patient Data, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

While COVID-19 has been ravaging almost the entire world, healthcare industries have been facing an unprecedented number of patients and challenges. Arguably, the US healthcare system has been hit the worst. Just look at the numbers – over 10 million cases with a record of 100,000 new cases for seven consecutive days. Unfortunately, things will get worse, as spikes are seen across the states and experts predict far more cases during the fall. Healthcare providers are facing huge challenges while they deliver care, while keeping patient and provider safety as a top priority. That being said, CMS (the Centers for Medicare and Medicaid Services) has mandated that caregivers must support sending and receiving e-notifications during ADT (admission, discharge, and transfer) events, something that many believe will help with improving patient safety and quality of care. Let’s take a closer look at the rule, how it will enhance care coordination, and why it requires accurate patient identification.

Interoperability has always been problematic

COVID-19 has already shown the importance of sharing patient data among caregivers. Most of the patients have multiple caregivers located at different sites, and for seamless care coordination and improved healthcare outcomes, their data needs to be shared accurately and in real-time with the appropriate parties. That’s exactly what CMS aims to achieve: improved interoperability between caregivers with patients in common.

Interoperability has been a massive issue within the healthcare space as caregivers fail to share patient data accurately, mostly because of patient identification issues – more on that later. In order to bolster interoperability, enhance coordinated care, and improve patient outcomes, CMS announced a new CoP (Condition of Participation) surrounding e-notifications as a part of their Interoperability and Patient Access Final Rule.

The new Condition of Participation (CoP) in a nutshell

This CoP requires applicable healthcare providers (critical access, psychiatric, and regular hospitals) that use digital medical records to share and receive alerts that are triggered in real-time due to ADT events – both inpatient and ED (emergency department) events. Applicable parties are PCPs (primary care physicians), post-acute care providers, and primary care practitioners, among others. The notifications should at the least include patient information, such as the patient’s name, the treating practitioner’s name, as well as the sending institution’s name. Caregivers can share more information if they deem it necessary.

The applicable healthcare providers need to support e-notifications by May 1, 2021. This means they have around half a year to comply with the requirements.

Why it is critical for improving patient safety

By sharing critical patient information with other parties across the care continuum, all of them can make informed decisions using the most recent data, leading to seamless care coordination and better healthcare outcomes – improving patient safety along the way.

Healthcare in the US has become multifaceted and complex – gone are the days when a patient would go to a single caregiver for receiving care. Now, a single patient can have multiple doctors that are located at different healthcare facilities. E-notifications enable such caregivers to quickly send and receive information that can lead to faster outcomes and better decision-making. When you compare it to previous methods – fax, phone calls, etc. – you will understand how this is going to change patient data sharing and interoperability. In time-sensitive cases, for instance, these real-time alerts will save lives.

How healthcare providers are addressing this CoP

Caregivers are brainstorming to identify the best way to address this CoP. Many will develop e-notifications solutions in-house, whereas others will use third-party solutions. While healthcare providers do that, they might overlook a crucial aspect that will make or break their e-notifications solution: patient identification.

To improve care coordination and interoperability efforts, e-notifications won’t be effective on their own – let’s see how.

Improving patient safety requires accurate patient identification

One serious but overlooked issue faced by healthcare providers is patient identification errors. Even during the pandemic, patient identification errors have been brought up a number of times, as they lead to delayed care, repeated lab tests, and can even hamper patient safety. But how exactly is this related to e-notifications?

It’s quite simple – imagine a hospital that does not utilize an effective patient identity verification solution. It is bound to face a number of issues, such as duplicate medical records, overlays, medical record mix-ups, and so on. Now, imagine that a patient is misidentified during registration; the entire caregiving process will be dangerous and inaccurate as it will use the wrong medical record. This will also hamper interoperability – false alerts will be sent out, raising credibility concerns. It will wreak havoc in the facilities that are associated with the wrong medical record. Thus, accurate patient identification is crucial for improving patient safety as well as making e-notifications work. Fortunately, RightPatient can help with that.

RightPatient has been improving patient safety

Used by several caregivers, RightPatient is the leading biometric patient identification platform for a number of reasons. First, it ensures hygiene as it is a touchless solution, eliminating risks of hospital-acquired infections. Second, it has a vast amount of experience over the years, making it a trusted name within the healthcare space.

By using patients’ photos, RightPatient locks the medical records. Patients are asked for a personal photo and a driver’s license after they schedule appointments. The platform matches the photos to verify the identities remotely.

When patients arrive at the hospitals, all they need to do is look at the camera – the platform identifies them using the saved photo and provides the appropriate medical record within seconds.

Use RightPatient now and eliminate misidentification, ensuring that you send out proper alerts to the correct caregivers, enhancing patient safety and care coordination in the process.

4 Strategies to Optimize Revenue Cycle in Healthcare and Mitigate Losses

November 24, 2020/12468 views / 0 Comments/in BLOG, Duplicate Medical Records, EHR, healthcare, Medical Record Mix-ups, Patient Identification, Patient Outcomes, Patient Safety, Revenue Cycle Management /by Matt Gibson

The US healthcare system has been going through a rough patch for a number of years now. When one problem is solved, other critical issues arise. However, with all these preexisting issues, it is now facing its biggest challenge in decades: COVID-19. With patients postponing regular visits and elective procedures, COVID-19 has created a severe financial strain and plunged hospitals and health systems into unprecedented losses. While hospitals are having to cope with these losses by closing down emergency departments, laying off employees, and so on, they can significantly reduce costs by focusing on their revenue cycles. Let’s explore why revenue cycle in healthcare is crucial, some strategies to optimize it, and how positive patient identification can help significantly.

Why is revenue cycle in healthcare important?

Revenue cycle management is one of the most crucial aspects of any given healthcare provider. In a nutshell, it is the series of events that starts when a patient schedules an appointment and ends when the provider receives payment and is reimbursed. Since it’s related to patient service revenue, it has a direct effect on any hospital’s bottom line.

If a hospital’s revenue cycle is optimized, then it will face higher margins, and if not, it will face significant losses. Complications such as billing and coding errors, patient misidentification at the front-end, and miscommunication lead to denied claims and delayed payments. In the end, patient volume won’t matter if a hospital takes a long time to capture the revenue or faces denied claims. Thus, optimized revenue cycle in healthcare facilities is extremely important if hospitals want to continue to operate in the foreseeable future.

4 Strategies to optimize revenue cycle management

Improve front-end and back-end collaboration

The front-end consists of activities where the hospital’s staff members interact with the patient directly: patient information collection, appointment scheduling, eligibility, verifying insurance coverage, upfront patient collections, and registration of new patients are just a few examples.

The back-end, on the other hand, consists of medical billing, claims management, denials management, as well as the collection of final “patient financial responsibility”.

Usually, when it comes to revenue cycle management, most healthcare providers have their front-end and back-end tasks separated. However, collaboration between the two can significantly improve revenue cycle management. Effective and seamless communication is the key, and if that can be facilitated between the front-end and back-end teams, then it will result in faster, more accurate, and improved collections.

Improve front-end activities

According to a recent webinar, half of denied claims incurred by hospitals can be traced back to front-end activities, with the top contributors being registration and eligibility issues. These ultimately cause issues at the back-end of the revenue cycle in healthcare facilities, and the caregivers are forced to allocate significant resources such as FTEs (full-time equivalents) to fix billing and coding errors. If the front-end issues are not addressed, then this will lead to an endless cycle of lower productivity and an unoptimized revenue cycle.

If the front-end processes can be improved by preventing common errors such as patient misidentification or missing patient information, then issues like claim denials, underpayments, and lower productivity of the FTEs can be vastly reduced. Automating the front-end workflow is just one step towards improvement – but more on that later.

Adopt revenue cycle automation

Revenue cycle automation is becoming more popular within the healthcare space, and for good reason. It leads to a significant reduction in the pressure that is put on healthcare professionals, reduces avoidable errors, and streamlines the entire process. However, organizations have to be cautious in their search for an effective automation tool.

Identify patients accurately

The most prominent issues that cause revenue cycle inefficiencies are patient identification errors, duplicate medical records, and medical record mix-ups at the front-end. If the accurate medical record isn’t identified, then the subsequent processes will be riddled with errors, leading to denied claims. Hospitals lose a huge amount of money – around $4.9 million – due to denied claims, many of which can be traced back to patient identification errors. Thus, revenue cycle in healthcare can be optimized if patient misidentification, duplicates, and mix-ups can be eliminated. This is exactly what RightPatient does.

RightPatient is a touchless patient identification platform that is used by several healthcare providers. It uses the patients’ photos to verify their identities, eliminating misidentification, avoiding duplicates, and preventing mix-ups at the front-end.

New patients need to take a photo during registration, locking their medical records with it. Enrolled patients only need to look at the camera – the platform identifies the patients accurately by matching the photos and provides the appropriate medical records within seconds.

By eliminating misidentification, mix-ups, and duplicates at the front-end, RightPatient ensures that the accurate medical record is used across the care continuum, eliminating denied claims, boosting bottom lines, and enhancing patient safety in the process.

4 Strategies Hospitals Use to Prevent Medical Identity Theft Cases

November 20, 2020/11266 views / 0 Comments/in BLOG, Data Breach, healthcare, Medical Identity Theft, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The US healthcare system has been plagued with several issues over the years. The lack of price transparency, interoperability issues, sky-high prices, and the lack of a standardized patient identifier are just some of them. One of the more concerning, and increasingly common, issues is medical identity, affecting more and more healthcare providers and patients. While providers are already facing huge losses due to the pandemic, they need to mitigate them by reducing preventable costs. One viable solution can be to reduce medical identity theft cases, and doing so will bring several benefits.

Let’s take a look at how medical identity theft happens, how common it is, and some strategies that can prevent it and mitigate losses.

How do medical identity theft cases happen?

Medical identity theft can occur in many ways, but it can usually be traced back to stolen patient information or records – a consequence of healthcare data breaches. There’s a reason why medical identity theft cases are so common: hackers are focusing more on healthcare data breaches because stealing and selling patient information is quite lucrative.

After a hospital suffers a data breach, the hacker(s) then tries to sell the stolen patient information on the black market. Unfortunately, there are many buyers available for many reasons, and they are also willing to pay high prices – up to $1000 per record!

After buying the stolen patient data, the fraudster assumes the identity of the patient. This can happen within healthcare facilities as well as during telehealth sessions (which are surging in popularity right now).

The majority of hospitals have no effective patient identifier and therefore they fail to red flag the individual, leading to medical identity theft. The scammer then illegally uses the victim’s credentials to obtain prescription drugs, medical equipment, and healthcare services, charging the victim for the services. Not only that, but since the fraudster uses the medical record, their information will be recorded within the EHR (Electronic Health Record) and can lead to patient safety issues down the line.

While that was a simple example, many complex medical identity theft cases are occurring almost daily.

Is medical identity theft common?

The numbers don’t lie –more patient records were breached in 2019 compared to the prior three years combined! Moreover, 9.7 million patient records were affected by data breaches this September. There’s no doubt that the majority of these patient records will be used for medical identity theft, as experts are also predicting a sharp increase in the near future.

Hospitals must ensure that they are preventing medical identity theft cases to guarantee patient safety and reduce associated litigation costs. Let’s take a look at some strategies that can help prevent medical identity theft and all of its consequences.

4 strategies hospitals can use to prevent medical identity theft cases

Follow the rules and regulations

First and foremost, the healthcare facility must ensure that they are properly following the rules. For instance, HIPAA mandates that there should be some technical, administrative, and physical safeguards present to protect patient information, known as PHI (Protected Health Information).

While this might seem like a straightforward strategy, a lot of healthcare providers fail to ensure HIPAA compliance. This not only leads to data breaches and medical identity theft down the line, but also incurs HIPAA penalties. HIPAA itself is a multi-layered and complex law that requires continuous effort to ensure compliance.

Fortunately, healthcare organizations can use HIPAA Ready, a robust HIPAA compliance software, to reduce the administrative burden. It streamlines HIPAA compliance, ensures training management, keeps all the HIPAA-related information in a centralized location, and also helps conduct internal audits.

By ensuring HIPAA compliance, healthcare organizations can detect security gaps and address the vulnerabilities, mitigating data breaches and, in turn, medical identity theft.

Devise a policy to enhance security

As previously mentioned, HIPAA has several requirements and requires that networks and devices are secure at all times. To do that, hospitals must come up with and follow a strict device policy so that sensitive patient information is not leaked inadvertently. While a BYOD (bring your own device) practice might be more flexible, it will inevitably lead to data breaches and leakage of sensitive information.

Thus, the following tips will help enhance security:

Only allow official devices for storing sensitive information
Only allow logging into secure networks
Encourage usage of VPN
Ensure data encryption at all times
Keep logs of access requests to track any suspicious activity

Train employees regularly

Staff members such as registrars and nurses are the ones who regularly access patient data. Training them will provide them with the knowledge to avoid suspicious emails, as that is the primary weapon of hackers. Moreover, providing regular training – especially if it includes information on recent data breaches – can be beneficial. As previously mentioned, HIPAA Ready can help with training management.

Ensure accurate patient identification

Even if a data breach occurs, medical identity theft can be prevented if healthcare providers can red flag the fraudster during identity verification. That is exactly what RightPatient does.

RightPatient is the leading touchless patient identification platform used by several caregivers. It verifies identities by using patients’ photos. After scheduling appointments, patients need to provide a personal photo and a photo of their driver’s license. The platform matches them and verifies their identity remotely, red-flagging fraudsters. This system is ideal for telehealth sessions.

During inpatient visits, the scammer is red-flagged when the platform identifies that their face does not match the saved photo attached to the medical record, preventing medical identity theft in real-time.

How to Improve Patient Safety and Add Millions to Hospitals’ Bottom Lines

November 16, 2020/10813 views / 0 Comments/in BLOG, Data Integrity, Duplicate Medical Records, healthcare, Medical Identity Theft, Patient Data, Patient Errors, Patient Identification, Patient Outcomes, Patient Safety /by Matt Gibson

The US healthcare system has been having a tough time for many years due to several issues, but the pandemic arguably tops all of them. It has damaged everything, leading to the cancellation of regular healthcare services in order to aid COVID-19 patients. While COVID-19 cases had decreased over time, cases rose across many states in the US. The American Hospital Association (AHA) also predicted that healthcare providers will face losses of at least $323 billion in 2020 due to the novel virus. As caregivers are still facing some of these challenges, as well as lower reimbursements, they can save significant costs and add millions to their bottom lines if they improve patient safety. Let’s take a closer look at the losses, what caused them in the first place, and how patient safety can be improved.

What contributed to the losses?

In short, a variety of factors contributed to the unfathomable losses. However, the key factors were elective procedures being canceled or postponed, drastically lower patient volumes, and high costs due to the surge in demand for crucial materials such as PPE (personal protective equipment). All of these were necessary so that caregivers could treat COVID-19 patients.

The losses didn’t stop there, which forced many healthcare providers to resort to cost-cutting strategies. Furloughing, laying off employees, restructuring the organization, introducing pay cuts, and even shutting down departments or entire healthcare facilities were just some common strategies seen during the pandemic. Unfortunately, there’s more bad news.

Hospitals reportedly received lower reimbursements for treating uninsured COVID-19 patients. It was estimated that the reimbursements might total from $13.9 billion to $41.8 billion. However, around $881 million has been provided at this point. Moreover, CMS fined half of the hospitals in 2021 as these hospitals readmitted patients too frequently. From every angle, hospitals are facing the worst financial strain in decades. Thankfully, these losses can be mitigated significantly if healthcare providers improve patient safety within their facilities with RightPatient.

How can RightPatient improve patient safety?

Ensures a hygienic environment

One aspect that makes RightPatient different from other patient identifiers is that it is touchless. The platform uses the faces of patients to verify their identities. In healthcare facilities, all a patient needs to do is look at the camera – the platform matches the saved photo and the live one for verification, making it a hygienic and safe experience for everyone involved.

Prevents medical identity theft

By identifying patients accurately across the care continuum, starting from appointment scheduling, RightPatient ensures that patients are who they claim to be and not some fraudster. After scheduling an appointment online, patients receive an SMS/email instructing them to provide a personal photo and a photo of their driver’s license – RightPatient does the rest. It red-flags any anomalies when it sees that someone else is assuming the patient’s identity, preventing medical identity theft in real-time.

When a scammer uses the victim’s medical record, it is contaminated with their data, rendering it dangerous, fragmented, and inconsistent. If such cases are undetected, they severely hamper patient safety and impact healthcare outcomes. Thankfully, RightPatient can prevent such cases and improve patient safety along the way.

Prevents duplicate medical records

Duplicate medical records are quite dangerous, as they lead to treatment based on incomplete and inaccurate medical data, creating incidents that hamper patient safety. RightPatient identifies patients right from the start, avoiding duplicates and overlays.

Protects patient data integrity

Patient data is useless and dangerous if it is corrupt, and such cases increase when patient misidentification is common. RightPatient eliminates patient misidentification and helps improve patient safety by using the most appropriate characteristic to identify them – their faces.

Reduces medical errors

Medical errors occur on a regular basis. In fact, a John Hopkins study claimed that each year, over 250,000 American patients lose their lives due to medical errors, whereas others claim the number to be above 440,000. This would make medical errors the third leading cause of death in the US, and as most of these errors stem from something as simple as patient identification issues, those deaths are preventable.

Imagine this – when a patient walks into the hospital, the registrar needs to identify their accurate medical record. However, if the wrong medical record is chosen, even if it is a duplicate medical record of the same patient, the treatment will be based on obsolete or incomplete information – even a single medication can severely hamper the patient’s outcome. RightPatient prevents these cases and eliminates preventable medical errors associated with misidentifications.

RightPatient can improve patient safety and mitigate losses simultaneously

RightPatient does all of the above and more – it reduces denied claims, litigation costs, and eliminates the costs associated with preventable medical errors. Leading caregivers have already experienced how useful RightPatient is and reduced losses significantly. Use RightPatient now to be a responsible caregiver and enhance patient safety, all while boosting your bottom line.

Hospital Readmission Prevention is a Must as CMS Fines Half of Hospitals

November 13, 2020/10752 views / 0 Comments/in BLOG, healthcare, Patient Data, Patient Errors, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety, value-based care /by Matt Gibson

The US healthcare system is in an unfortunate state – it just can’t seem to catch a break. While it was already coping with a number of issues – such as medical identity theft, the lack of price transparency, interoperability issues, and healthcare data breaches, among others – COVID-19 hit it hard. As a result, healthcare providers across the US are facing huge losses. With increasing COVID-19 cases across the States and with experts predicting even more during the fall, healthcare providers received yet another blow. CMS (Centers for Medicare & Medicaid Services) will fine about half of hospitals due to readmissions of Medicare patients, although this is for the pre-pandemic period and therefore COVID-19 cannot be held accountable for the lower payments. Let’s take a look at the numbers, how this will affect the hospitals further, and how hospital readmission prevention can be achieved with a proper patient identity verification platform.

CMS will lower payments

While it’s already been quite a harsh year for healthcare providers, it’s about to get worse. Many caregivers are resorting to cost-cutting strategies by laying off employees, furloughing them, or even shutting down; however, the lowered payments will only add to the unprecedented costs.

Some numbers surrounding the penalties

During the fiscal year 2021, CMS will fine 2,545 hospitals due to increased Medicare patient readmissions that occurred within 30 days. The penalties were based on patient data ranging from July 2016 through June 2019. A staggering 83% of the hospitals received penalties, and they will be facing payment cuts as high as 3% per Medicare case during 2021. 39 caregivers will face the maximum penalty next year, which is an improvement over this year, when the number of hospitals hit with the maximum penalty was 56. However, with the pandemic disrupting everything, hospitals will lose more than ever. As a result, hospital readmission prevention becomes a topmost priority.

Why is the program important?

This is the ninth year of the Hospital Readmissions Reductions Program, and it has been created to improve patient care quality while lowering overall costs. As previously mentioned, it takes into account the readmissions of Medicare patients that occur within 30 days. While CMS is considering a suspension of the penalty program due to COVID-19, the penalties are still in effect this year.

Some exceptions

Congress has exempted 2,176 hospitals out of the 5,267 from penalties due to a number of reasons. The hospitals exempted are either:

Critical access hospitals,
The only inpatient facility in the area,
Hospitals specializing in long-term care, children, veterans, or psychiatric patients.

What the industry thinks about hospital readmission prevention

While many participants within the US healthcare system have voiced disapproval regarding the penalty program, others have said that, while not perfect, the Hospital Readmissions Reductions Program is useful – it pushes caregivers to find innovative solutions to provide better quality care.

The penalties will further increase hospital losses

Moreover, as healthcare providers are already facing huge losses due to the pandemic, they need to ensure hospital readmission prevention if they want to survive in the long run. Several hospitals are heavily relying on CMS reimbursements, and if they can reduce readmissions, it might help them survive the pandemic’s financial strain. By improving patient safety and quality of care, hospitals can significantly lower readmissions. Fortunately, RightPatient can help with that.

RightPatient enhances hospital readmission prevention

RightPatient has been helping leading healthcare providers with its touchless patient identification platform for years. It ensures improved healthcare outcomes by eliminating one of the most overlooked problems within hospitals: patient misidentification.

Patient misidentification leads to duplicate medical records and overlays, jeopardizing patient safety. Moreover, it provides the wrong medical records to caregivers, resulting in negative healthcare outcomes. Naturally, these are the patients who are readmitted within hospitals frequently. So, how does RightPatient help?

It locks the medical records of the patients using their photos during registration. Patients receive an SMS/email after they schedule appointments, and they are required to provide a personal photo and a photo of their driver’s license. RightPatient compares the photos for a proper match, eliminating any chance of misidentifications. All of this is done without requiring the patients to touch any foreign objects, eliminating infection control issues – something that is crucial during and after the pandemic.

Reduce patient readmissions, improve healthcare outcomes, and ensure patient safety with RightPatient – contact us now to learn how we can help you.